Another one of Dr. Sarah’s Adventures:

Opium has had a chequered history down the ages. But did you know that it was once upon a time a drug of choice to treat a plethora of ailments in babies and children as well?

Even the Ancient Egyptians would deal with their noisy crying babies by just giving them a draft of opium. It’s interesting to know that it was still the drug of choice in the Victorian era, till it gained notoriety for the dangers of opiates in children and the significant adverse effects on their general health.

Historically we know that in the Victorian era opium was commonly used as a cure-all for coughs, or aches and pains in adults. But it is less well known that restless or teething babies and even very small infants would be given different concoctions that contained opium or morphine (an opium derivative). Attitudes towards the administering of opium to children were often casual, and popular preparations such as laudanum even recommended doses for children and infants on the labels of their bottles.

Opium was at that time period often described as the ‘Poor Child’s Nurse’, due to its ability to stop hungry babies from crying and disturbing the household where their mothers worked. Thankfully, the doctors of the era were convinced that opium was a major cause of infantile death, especially with its use becoming widespread amongst working class families.

Usually on my drive to work, I had to wait at a busy traffic intersection before I could turn into the road where the hospital was situated. The morning rush hour was at times so heavy that the lights changed a few times till I was able to get to the point where I would be able to turn. While sitting in the car there was not much to do, so I would either listen to music, or look around and “people-watch”.

The young girl would be at the crossroads every day. Without fail she would be standing quietly at the same traffic light for months on end. It was as if she had made that junction her home. In the beginning when she was younger, she used to be alone, or accompanied by a stern looking woman who I presumed was her mother. As she grew older, I noticed that she would sometimes be standing in the sweltering heat cradling a small bundle in her arms, that, in the fleeting glimpse I got of it while passing by, wouldn’t move or even give the impression that there was any sign of life.

One day, when the traffic lights took their time to turn green, she tapped on the window of my car and started to beg for alms. She uncovered her baby’s face and said she needed the money to buy milk and medicines because her child was ill. I looked carefully and noticed that the baby, a little girl, did look pale, and somehow her breathing was very shallow. The odd thing was that even though she was fast asleep, she was oblivious to the loud cacophony from the traffic.

Giving the baby a quick glance, I told the girl that since she said the baby was ill, she should bring her to me at the hospital, where I would examine her properly and give her some appropriate medicine. In the short time I had before the light turned green, I quickly threw my card at her and told her to come to the ward on the third floor of the Children’s Hospital as soon as she was able to.

Obviously, she didn’t come to the hospital as was expected, and it dawned on me that she was in fact not at all concerned for the child. She just wanted the money she could get by playing on the sympathies of the motorists who she targeted at the traffic junction. I had felt there was something dispassionate and distant with her attitude towards the baby. I could not feel any maternal vibes coming from her. Was the baby really hers?

The next time I saw her at the traffic lights, I asked her why she hadn’t come to the hospital. I tried to reassure there that the treatment and the medicines were free. She looked furtively around and saw that the woman I thought was her mother, was looking at us with a stern expression. Becoming aware of the woman’s malevolent stare, she suddenly looked scared and didn’t want to talk to me anymore. Giving a quick look at the sleeping baby I once again found it strange that there was no movement or response to any stimuli, whether physical or auditory. Before I drove off, I flippantly asked her what she had given to the child to sleep so soundly, because I couldn’t get my patients to sleep so deeply. Instead of laughing or brushing off my joke, she looked even more frightened and turned away from my car so abruptly that she caught her foot on a stone and tripped falling face first onto the road. The baby obviously also fell from her arms onto the curb. She just moaned slightly and went on sleeping. That was when I became even more suspicious that the child must have been heavily drugged. Not only that, but I also noticed that the baby was not breathing well and looked even more pale than the first time I had seen it.

Looking for a nearby place to park, I tried to find the girl to take her and the baby to the hospital, but by the time I was able to walk back to the intersection, she and the old woman had taken the baby and disappeared. I asked a few passersby and another one of the regular beggars there whether they knew where they had gone, but either no one knew, or they were not saying where they went.

Disappointed and worried I went back to my car and went to work as usual. But the baby’s condition did lay heavy on my conscious. I hoped she was all right and that my suspicions were unfounded….but then, why didn’t the baby cry when it fell down with the mother? Strange thoughts and “what ifs’ were continuously swirling around in my head. I just could not put them out of my mind. Maybe it was a grim premonition? Or was it just that I knew too much about the detrimental effects of drugging babies and was frustrated because I wasn’t able to help them. The question was, did they want to be helped? I guess not since they slipped away once I showed an interest in the health of the baby. I tried to put them out of my mind, and yet I couldn’t do so.

Mentioning my strange encounter of that day to one of my colleagues, she told me that these things were common in a big city. Was she hinting that I was a country hick? Well, I did study in a smaller town, so I took her barb as it was meant, a joke. She also told me a frightening story of gangs who “hired” babies from poor parents for these begging stints. Many times, the “mothers” we saw on the road were only regular beggars with no relationship to the baby at all. These gangs would take the babies along with them and they were usually drugged to the gills. The drug of choice was opium because it was easily available, and in their uninformed minds, it didn’t seem to affect the babies that much. They usually gave the baby an exceedingly small quantity (I was told that it was a bit of opium paste the size of a rice kernel). This ensured that while they were on the streets, the babies wouldn’t cry or demand any feeds, and by the time they took them back to their real mothers, the drug would have started to wear off. My colleague also told me to keep my eyes open and look around the area where I encountered these beggars. There would always be an elderly woman or man sitting or standing nearby keeping an eye on the wretched “working” woman, and many times one could see that they would immediately take the alms away from her as soon as she received them.

The next day, just when I started my ER shift, I was surprised to see “my” beggar there looking very worried indeed. The moment she saw me enter she ran to me and pulled me towards an examination cubicle. She was nearly hysterical, and I could hardly understand what she was trying to tell me. She kept on babbling about not wanting to be a murderer. When I saw the baby lying helplessly there on the examination bed, I understood immediately why she had sought me out. To her I was a somewhat known entity in the frightening and unknown world of the hospital.

Looking at the baby I observed that it was pale as usual, but to my dismay she was unresponsive to any stimuli and had very shallow breathing. Keeping in mind my colleague’s story, I examined her pupils and saw that they were constricted to a pinpoint. There! I found my answer immediately. Just as I was in the middle of examining the baby, she stopped breathing. Immediately a code blue was called, and we started to resuscitate the little one. It was a tedious job and time seemed to have slowed down. The team was working with excellent coordination, but even though only minutes had passed it seemed as if we were working on the baby for hours. We were finally able to resuscitate her as per the Basic Life Sciences (BLS) and Paediatric Advanced Life Support (PALS) guidelines and after giving the antidote for opium, the baby soon responded to our resuscitative efforts and started to cry. Believe me when I say that we were all so relieved! It was as if the baby was reborn!

While we were working on the little baby, my colleague called my friend Chief Inspector Tanya. We had to report the incident since it was a case of accidental poisoning of a forbidden substance.

Seeing  Tanya was such a relief. Going against such gangs was dangerous on any given day, but with the support of the police, at least some children could be helped. At least I sincerely hoped so.

Tanya and I asked the girl, whose name was Marvi, what she had given to the baby just to be sure. At first, she tried to lie and said that she hadn’t given the baby anything, she was just sick. I told her that she couldn’t fool a doctor, especially one who had just resuscitated the baby, and I was adamant that she told me the truth. I wanted her to speak out in front of  Tanya. Finally, she broke down and told us that her “mother” had given the baby some opium. She said that they usually just gave it a small amount, but today the usual amount didn’t seem to affect the baby, and she kept on crying so on her own volition she gave her a bit more. After a while she saw that the baby was quieter than it usually was, and she realized to her horror that she had overdosed the child. While she panicked, she had an epiphany and remembered that she had pushed the card I had flung at her into her pocket. She literally ran as quickly as she could to the hospital and made her way to the ER showing the card to the staff to ensure that she was in the right place.

Once the baby was stabilized, I handed the now crying baby over to the ER nurses for supportive treatment and possibly for a bottle. In the meantime, we took Marvi to an adjacent seminar room and started to question her about the gang she was involved in. At first, she didn’t want to answer honestly but then I told her that if she had come just a few minutes later the baby would have died, and she would have been in police custody by now. Therefore, if she wanted to be helped, she needed to be honest with us.  Tanya assured her that she would be taken care of because she was as much a victim as the baby. Marvi was also told that if she helped the police with information about the gang, many innocent lives would be saved.

As her story unfolded ,we realized that it was sad and horrifying. As we suspected, the baby did not belong to her. As a matter of fact, she had never been married. She was only 17 years old. She didn’t know who her parents were because she was bought by the “Mother” of the gang of girls that she belonged to. This mother would “hire” babies for a day from poor people who needed money, and the girls were told to take them along when they went begging. It wasn’t always necessary that they had the same baby every day. It depended on who was available at the time. This modus operandi was more prevalent at the times of festivals and celebrations because people were supposed to be more generous with their alms at these times. However, in the “quiet” months they stayed in a gypsy camp at the outskirts of the city.

She confirmed that all of the babies “hired” were always fed opium to keep them quiet and complacent during the time they had them. They were easier to handle that way. Also, since they were sleeping most of the time, they weren’t hungry and so they didn’t need the usual feeding paraphernalia that a baby needed. Poor, poor babies. I felt so sorry listening to her tale. What sort of parents rented their babies to such scum? Were they driven by desperation or were they just uncaring?

I asked this of Marvi, and she told me that many families were dysfunctional themselves. It was quite common that the men of the family were drug addicts and the women had to either go to work, or they had so many children that they couldn’t leave them alone in the hovels or gypsy camps where they lived. Their thoughts were that for the safety of the other siblings, wasn’t the sacrifice of one baby justified?

Tanya immediately went with her team and arrested the ring leaders of the gang. They had to follow “Mother” and keep her under surveillance for a few days till they found out where she operated from. To her surprise they didn’t live in the hovels where their beggars lived. The husband-and-wife ringleaders were masquerading as a respectable couple whose children were studying abroad in well-known universities. They lived in the height of luxury in one of the upscale areas of the city and drove around in large cars. That was quite a weird twist in the tale. Her modus operandi was quite simple. A rickety rickshaw would pick up the woman every day every day at the same time after dawn. She would be dressed in rags. Her chosen transport would take her to the ramshackle dwellings of her beggars. The same rickshaw picked her up from there in the evening and dropped her at her house once more.

Through an informer, Tanya found out that corrupt officials would ask the beggars to pay for the choicest corners and intersections in the city. Usually, they were the traffic cops working there. That problem was thankfully noted and handed over to the department of Internal Affairs of the Police.

Anyway, the requisite arrest warrants were procured from the court, and the house was searched. I think someone must have tipped off the media because the next thing we knew was that the story made headline news. From the news video we were able to see stacks of foreign and local currency that was found in a hidden safe under the floor. Jewelry worth millions was also recovered. When that was itemized, Tanya recognized a few expensive pieces that had been reported stolen. Of course, the other jewelry was then also considered stolen or maybe bought with stolen money.

The Husband and wife were quite vocal in implicating their gang members once they were caught, and I am sure that you will agree with me that the long sentence combined with hard manual labor for all of them was well deserved.

We found out that there were 15 girls that were supposedly “employed” by them. All ranging from the ages of 12 to 20. They were relieved to be free from the shackles of the evil couple because they had been told that they would be sold to another gang as prostitutes if they did not bring in a certain amount of money every day. That threat weighed heavily on them, and that was the reason why they were so pushy when they begged.

With the help of a couple of philanthropic groups we were able to accommodate some girls in shelters and some of them were given jobs as domestic help. A few of them even asked to go to school which was quite heartening.

Happily, since that significant raid, the police have been collaborating with the Government and are strictly cracking down on the gangs. Begging was always considered illegal, but with the authorities turning a blind eye, it had become uncontrollable, and gave the gangs leeway to exploit innocent people. Nowadays, there are special police patrols especially designated to pick up beggars and homeless people from the roads to take them to specifically appointed shelters. Those that need help in repatriation to their villages, want to go to school or need jobs are helped. But there are also those habitual transgressors who don’t want to be helped at all. For them, there is nothing one can do about their situation.

Where I am concerned, I am just happy that the number of children with opium poisoning has definitely reduced quite drastically. Overdose cases for that age group has become thankfully rare.